CRA Community Development Loan Report

Please use this form to report each community development loan made.

Please send completed forms to the CRA Compliance Officer.

Be sure to keep a copy in the credit and collateral loan files for examiners to review.

Loan Recipient: ______

Date loan made: ______/______/______Loan Number: ______

Original loan or commitment amount: $______,______,______

Renewals count as new originations. Only one renewal can count for the year unless there is an increase in the loan amount. Then only the amount of the increase will count. If applicable:

Date of renewal: _____/_____/_____ Amount of increase this renewal: $_____,_____,_____

Primary purpose of the loan: (Please check all that apply.)

[ ] Affordable housing (including multifamily rental housing) for low- or moderate-income people

[ ] Community services targeted to low- or moderate-income people (such as health care, educational, job training, social, child care, credit or financial services)

[ ] Revitalization or stabilization of low- or moderate-income areas

[ ] Promoting economic development by financing small businesses or small farms

[ ] Other: ______

Description of Loan Recipient: (Please check all that apply.)

[ ] Borrower for affordable housing rehabilitation and construction, including construction and permanent financing of multifamily rental property serving low- and moderate-income persons.

[ ] Not-for-profit organizations serving primarily low- and moderate-income housing or other community development needs.

[ ] Borrower to construct or rehabilitate community facilities that are located in low- and moderate-income areas or that serve primarily low- and moderate-income individuals.

[ ] Financial intermediary that primarily lends or facilitates lending to promote community development. Examples include Community Development Financial Institutions (CDFIs), Community Development Corporations (CDCs), minority- or women-owned financial institutions, community loan funds or pools, and low-income or community development credit unions.

[ ] Local, state, or tribal government for community development activities.

[ ] Borrower to finance environmental clean-up or redevelopment of an industrial site as part of an effort to revitalize the low- or moderate-income community in which the property is located.

[ ] Other: ______

Who ultimately benefited from this community development loan? (Check all that apply.)

[ ] Low- or moderate-income persons/areas [ ] Females

[ ] Disabled individuals [ ] Senior citizens

[ ] Small businesses and/or small farms [ ] Other: ______

Originating Officer: ______

Originating Office: ______

CRA-4 Revised 6-17-02

Southern Community BanCorp Compliance Department